Provider Demographics
NPI:1134269442
Name:SEGELCKE, HARRIET MARY (DC)
Entity type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:MARY
Last Name:SEGELCKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:HARRIET
Other - Middle Name:MARY
Other - Last Name:SEGELCKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:225 CABRILLO HWY S STE 110D
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1738
Mailing Address - Country:US
Mailing Address - Phone:408-384-1186
Mailing Address - Fax:
Practice Address - Street 1:225 CABRILLO HWY S STE 110D
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1738
Practice Address - Country:US
Practice Address - Phone:408-384-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor